Advertisement

Ablation above the semilunar valves: When, why, and how? Part II

  • Mahmoud Suleiman
    Affiliations
    Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
    Search for articles by this author
  • Samuel J. Asirvatham
    Correspondence
    Address reprint requests and correspondence: Samuel J. Asirvatham, M.D., Division of Cardiovascular Diseases, Associate Professor of Medicine, Mayo Clinic College of Medicine, 200 First Street Southwest, Rochester, Minnesota 55905
    Affiliations
    Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
    Search for articles by this author
      In this two-part series on arrhythmias occurring above the semilunar valve, we discuss the relevant underlying anatomy and the technique for mapping and ablation above the aortic and pulmonic valve. In part I, we focused on ventricular arrhythmias, and in this paper (part II), we discuss the anatomy and present knowledge of the substrate mapped and ablated above the aortic valve for atrial tachycardia in certain unusual accessory pathways. The background anatomy of the aortic valve has been discussed in part I of this series, to which the reader is referred. Here we discuss the detailed anatomy of the aortic cusps relevant for atrial tachycardia and atrioventricular bypass tracts. Representative cases of these supravalvar arrhythmias are presented, and an approach for safe and effective ablation above the aortic valve to eliminate atrial tachycardia and bypass tracts in this location is then outlined.

      Keywords

      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Heart Rhythm
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Gami A.
        • Venkatachalam K.F.
        • Asirvatham S.
        Successful ablation of atrial tachyardia in the right coronary cups of the aortic valve in a patient with atrial fibrillation: what is the substrate?.
        J Cardiovasc Electrophysiol. 2008; (PA) (Feb 21 [Epub ahead of print])
        • Yamada T.
        • Huizar J.F.
        • McElderry H.T.
        • et al.
        Atrial tachycardia originating from the noncoronary aortic cusp and musculature connection with the atria: relevance for catheter ablation.
        Heart Rhythm. 2006; 3: 1494-1496
        • Asirvatham S.
        Anatomy of the vena cava: an electrophysiological perspective.
        in: Chen S. Haissaguerre M. Zipes D. Thoracic Vein Arrhythmias: Mechanisms and Treatment. Blackwell/Futura, Malden2004: 54-65
        • Das S.
        • Neuzil P.
        • Albert C.M.
        • et al.
        Catheter ablation of peri-AV nodal atrial tachycardia from the noncoronary cusp of the aortic valve.
        J Cardiovasc Electrophysiol. 2008; 19: 231-237
        • Jackman W.
        • Wang X.
        • Friday K.
        • et al.
        Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson-White syndrome) by radiofrequency current.
        N Engl J Med. 1991; 324: 1605-1611
        • Huang H.
        • Wang X.
        • Ouyang F.
        • et al.
        Catheter ablation of anteroseptal accessory pathway in the non-coronary aortic sinus.
        Europace. 2006; 8: 1041-1044
        • Suleiman M.
        • Powell B.
        • Munger T.
        • et al.
        Successful cryoablation in the noncoronary aortic cusp for a left anteroseptal accessory pathway.
        Journal of Interventional Cardiovascular Electrophysiology. 2008; (in press)
        • Miyauchi Y.
        • Kobayashi Y.
        • Morita N.
        • et al.
        Successful radiofrequency catheter ablation of an anteroseptal (superoparaseptal) atrioventricular accessory pathway from the left ventricular outflow tract.
        Pacing Clin Electrophysiol. 2004; 27: 668-670
        • Nakagawa H.
        • Jackman W.
        Catheter ablation of paroxysmal supraventricualr tachycardia.
        Circulation. 2007; 116: 2465-2478